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Thursday, October 31, 2013

Health
Care and Your Private Affairs Are Personal

The
personal life of every individual is based on secrecy, and perhaps it is partly
for that reason that civilized society is so nervously anxious that person
privacy should be respected.

Anton
Chechov (1860-1904), The Ladywith the Dog

Every American knows health care and your private
life are personal matters.

That is why most people want a personal physician,
not necessarily a health care team; why many are wary about healthcare.gov,
which asks for your personal data,including
your social security number; why they want their health care information kept
confidential, between them and their doctor; why people are leery about the
National Security Agency’s surveillance system collecting personal information from
Google and Yahoo data streams; why people are upset that healthcare.gov asks
for personal information before allowing
you to scan and compare health plans on the exchanges; why people are so upset
that their personal health plans are being cancelled, when it was promised that
they could keep their plans if they liked them; why governmental personal
health information gathering is regarded
as an intrusion into personal freedom.

Suddenly
It’s Not about Politics, It’s about Me

Suddenly,it’s
not the politics, it’s the intrusion into my personal affairs. my personal
decision making,and my personal right
to choose. Suddenly, it is not a question of Democrats versus Republicans,single payer versus market-driven care,government compassion versus cold hearted
business practices,liberals versus
conservatives, President Obama versus his critics. It’s about me.

It’s
Personal and About Other Things

It’s personal. It’s about losing my health plan,
which I like and which I chose.It’s
about the health security of myself and my children.It’s about what I can afford..It’s about spending hours and even days and
weeks plowing through a website that
doesn’t work and don’t understand and
scratching my head over policies the government can’t seem to explain. It’s about misleading promises and deceptive caveats.

It’s about unexpectedly cancelled policies, disappearing
doctors,and rebooted promises.It’s about a sick economy, absent jobs, and doubling and tripling of government dependency
programs. It’s about government policies, which federal officials understood in 2010, but did not explain, that might cause 93 million Americans to lose their
health plans.It’s about the big glitch that failed .It’s about cramming down government policies
that crimp my freedom to choose.

It’s about personal expectations,being able to see my doctor in a timely
fashion,to choose my own plan on my terms,to have access to the latest treatments and
procedures.

It’s about the unfairness of Congress and government
officials being spared from Obamacare.It’s about politics becoming personal, affecting me and my family in the
concrete rather than the abstract.It’s
about what Abraham Lincoln said of politicians, “Politicians are a set of menwho have interests aside from the interests
of the people, and who, to say the most of them, are, taken as a mass, at least
one long step removed from honest men. I sau this with the greater freedom, because, being
a politician myself, you can regard it as personal.”

When it comes to infringing upon your health care and your personal affairs, and to slow economic growth, lack of jobs, and cancelled health plans, to paraphrase Lincoln, you may fool all of the people of the time; you can even fool some of the people all of the time, but you can't fool all of the people all of the time. You can't infinitely delay the day of reckoning.

Tweet:Your health and your private life are personal;
government asking for your health data and cancelling personal policies are off
limits.

“If you had one of these substandard
plans before the Affordable Care Act became law, and you really liked that what
we said, under the law, you have got
to replace them with quality, comprehensive coverage.”

President Barack Obama,Boston Political Rally, October 30, 2013

In Boston yesterday,President Obama
blasted health insurer “bad apples” by saying these insurers were offering “substandard”
plans.By “substandard,”he meant those 19 million existing health plans that did
notcontain the 10 “essential benefits”
his administration considered “standard”.

These “benefits” include:

1.Outpatient
care—the kind you get without being admitted to a hospital

2.Trips
to the emergency room

3.Treatment
in the hospital for inpatient care

4.Care
before and after your baby is born

5.Mental
health and substance use disorder services: This includes behavioral health
treatment, counseling, and psychotherapy

6.Your
prescription drugs

7.Services
and devices to help you recover if you are injured, or have a disability or
chronic condition. This includes physical and occupational therapy,
speech-language pathology, psychiatric rehabilitation, and more.

10.Pediatric
services: This includes dental care and vision care for kids

The
Administration’s Message

Never mind if you do not need or want these benefits.Never mind if they do not apply to you, your family,
or your health situation. Never mind if you can afford them or not.Your pre-existing plans that do not have
them are kaput. According to the law,insurers will have to cancel them, and you will have to shop around on
healthcare.gov or state exchange websites to replace those substandard plans.

Message Raises These Questions

What does this message imply?

That?

·Health insurers are dishonest and unscrupulous
in offering policies that do not cover everything clinical and preventable. Calling some insurers “bad apples” implies insurers are not honest and above
board in their dealings with the public.
Insurers are the "demons" of our health system.

·Government and only government knows what
standards should apply to the electorate and
their families. After all, it was the first President, George Washington, who
said at the first Constitutional Convention “Let us raise a standard to which the wise and
honest can rise.”

·Insurers conned millions of honest Americans into
buying plans that they knew did not meet government standards and that they dishonestly knew to be
inadequate.

·Citizens who bought these plans and who pay
monthly for them must be protected as set forth in the Patient Protection and
Affordable Care Act.It is our patriarchal
duty to protect citizens against the unscrupulous in the health care industry.

·If the premiums and deductibles are “unaffordable.
“ it is the function of government to step in and provide subsidies to make
them affordable.

·Because of lack of consumer wisdom and
knowledge, freedom of choice of health plans outside of government approval of plans on the exchanges is no
longer an option.

Tweet: Insurers must cancel all “substandard” health plans that do not contain
10 essential benefits mandated by the health law.

Wednesday, October 30, 2013

Marketing Strategy, and a cliché that has been
in common use for five decades

As I view
cancelling of health policies for millions on the individual market, who
represent 7% of Americans under age 65,these thoughts spring to mind.

These
cancellations reflect a political philosophy that says,

·Eat
your broccoli, it’s good for you.

·Government
knows best, you do not know what is good for you.

·Only
government knows what is good for your health.

·It’s
not what you want or need or are willing to pay for, it’s what government wants you
to have and what you must pay for.

·No
matter what you think you need, you must pay for what others need.

·It
is not whether; don't dither; it’s what youmust do; we are all in this together.

·Birds
of different feathers must flock together.

·In
the name of equity, government plans are
“better” because they cover every eventuality,everybody must have more comprehensive plans,
even if they are more expensive; it's all right for the White House to tell an untruth as long as it is for your own good.

·Everyone
is the same,regardless of gender, age, or
health, or risk, and whether one has been on a bender.

·You
can’t keep the plan you like,only the
plan the government likes.

·If
you like your plan, forget it.

·Individual
choice or freedom of choice has no place or space in the scheme of things;
that’s up for government to decide.

·Health
plans are the enemy because insurance rests
on the assumption that calculating premiums is based on risk.

Let’s
say you’re a health plan executive.Your
stakeholders want a return on investment. This return depends on your company
growing and making a profit. ObamaCare
threatens this investment and the profit by putting a lid on marketing on
management , forcing you to drop plans that don’t meet minimal governmentstandards,raising the cost of doing business because of
onerous regulations, and cutting your return by 7% or so on Medicare
Advantage Plans.

What
to do?You drop physicians decreasing
your profit from the physician network by cancelling their contracts.

It
isn’t rocket science.

What – You look at what doctors are
costing you money, and you determine it is physicians who order the most
tests,perform and most tests and
schedule the most visits..

Why
-You consider the reasons why is that these
physicians regularlyspend more on
average ofpatients’ premium dollar than
other physicians.

When
– You drop these
physicians out of your network, i.e., the physicians with whom you do
businessbefore January 2014,when ObamaCare kicks in in earnest in January
2014.

How
– You
simply review your claims data and cut out 10% to 15% of doctors who are
ordering the most Medicare Advantage services.

Where-You do it in those physician markets where Medical
Advantage costs are high and physiciansand their associations are more tractable, then you do it nationally.

Who
-You pick the physician who are high rollers,
and you do it in the names of efficiency and quality – without mentioning the
unmentionable – profit.

It
is all done on the basis of sound business principles.That’s why United Healthcare and other health
plans is dropping 10% to 15% of its doctors from Medical Advantage Plans, and
why it will force man seniors to find new doctors or change plans.According to Todd Baker, director of
professional relations with the Ohio State Medical Association, “This is one of the most
significant (provider) network narrowing’s we've ever seen in the Medicare
Advantage world,”

As
nearly as I can tell from multiple sources, about 25% of 50 million Medicare recipients
are on Medicare Advantage plans.This
amounts to 12.5 million people.If
United and other health plans drop 10% to 15% of those in Medicare Advantage plans
that would mean 1.25 million to 1.87 million seniors would have to switch
doctors.

A
small number, to be sure, when you consider 50 million Americans are on
Medicare.But losing your doctor is
irritatingif you are a Medicare recipient whose doctor
is being dropped,And it may anger you if you believed President Obama in 2009 when
he promised, “ If you like your doctor,you will be able to keep him. Period.” In the case of Medicare Advantage
plans,a period has become a question
mark.

Tweet:Insurers may drop 10 to 15% of doctors
involved in Medicare Advantage plans, meaning 1 to 2 million seniors may have
to switch doctors.

Monday, October 28, 2013

The president lack of awareness about adverse events
is astonishing.He must live in aisolated impenetrable bubble,isolated from public opinion and advice from
his political advisors.

Otherwise, how could he possibly and conceivably be unaware
that:

·he
did not know the IRS was targeting conservatives when the IRS head made over
150 visits to the White House over the course of a year before the scandal
broke;

·the IRS official responsible for the
targeting would operate out of the White
House and would direct ObamaCare implementation;

·where he was or what he said the night
of the Benghazi attack could not remain
amystery because it doesn’t wash;

·his National Security Agency was monitoring
the phone calls and e-mail messages of other world leaders:

·his promises that people could “keep
their health plans and doctors, period.” was false and misleading - period;

·online marketing of his namesake landmark domestic achievement was
unteste and not ready for primetime and would be a healthcare.gov disaster ;

·ObamaCare would potentially cause insurers
to abruptly cancer middle class health
policies of as many as 16 million people;

·85% of Americans who liked their policies
would not only lose their plans but their choice of doctors as well;

·two-thirds of people in individual and small
group markets and the young and healthy would see premiums and deductibles rise
and be told government endorsed plans
were “better” and would be for their own good because the new plans offered services
many patients felt they did not need but others did. People are asking, "Why can't I just keep what I have?

Why did he not know these things? Was it false pride, hubris, or arrogance? Why did he not examine the consequences of
his policies beforehand?These mishaps
and lack for foresight strain the credibility of the President’s
leadership.The president should lead
and take responsibility for his administration’s actions rather than follow
from behind and blame others for failed policies.

Tweet: President Obama and defenders say he is
unaware why bad things happen to one with
good intentions; ignorance is no longer a sufficient excuse.

A capitalistic society does not want
more than two cheers for itself.Indeed,
it regards the impulse to give three cheers for any social, economic, or
political system as expressing a dangerous – because it is misplaced –
enthusiasm.

Sunday, October 27, 2013

Don’t
Know Much about Geography, but I Do Know Something about Healthcare. gov

Don't know
much about geography

Don't know
much trigonometry

Don't know
much about algebra

Don't know
what a slide rule is for

But I do
know one and one is two.

Lyrics,
by Sam Cooke, of What a Wonderful World, based
on book by Kenneth Davis,Don’t Know Much about Geography

I don’t know much about geography, but I do know
something about healthcare.gov

I know 14 states run their own state exchanges
(California, Colorado,Connecticut ,
Hawaii, Kentucky, Maryland, Massachusetts, Minnesota, Nevada, New York,Oregon,
Rhode Island, Vermont, and Washington); two (New Mexico and Idaho) run their exchanges using the federal exchange
infrastructure; and the other states depend on the federal government to create and
manage their exchanges.

I know most of those states who run their own
exchanges are blue or purple states, while most of those who let the federal
government do their exchanges are Red states.

I know the state exchanges are functioning better
than the federally run exchanges.

I know the federal government has yet to get its
technological act together after spending roughly $1 billion and3 ½ years to prepare for healthcare.gov.

I know the federal government says that
healthcare.gov will be ready to go by November 30,that December 15 remains the drop dead date
for enrolling,and that by January 1 everything
will supposedly be ready to go.

I know that almost everybody – Democrats and Republicans
and the public at large – consider the rollout a “disaster.”

I know the enrollment period will be
extended to March 1, and that nobody will be penalized for not signing up.

I know that penalizing someone for not enrolling when they have no means of enrolling makes not sense.

I know the middle class making more thant $46,000 and not eligible for subsidies will rise up in anger when they learn their premiums and deductibles are higher and often unaffordable because of services they do not think they need.

I know that one function of healthcare.gov, the ability to browse and compare health exchange plans, was changed so that this information was not available until after people had enrolled.

And I know that the number of expected enrollments
are behind schedule,that only about 25%
of those who create accounts have so far enrolled, and that the number of plans
being cancelled because of the inability to meet ObamaCare standards far
exceeds those being enrolled. It is
estimated 16 million policies will be cancelled over the next several
months;how many people will enroll or
take Medicaid plans is unknown, but it likely to far short of 16 million.

In the meantime, as of this date, October 27, the AdvisoryGroup says 116,000 people have picked a
private planor enrolled in
Medicaid.The federal government
estimated 500,000 would have done so by October 31.So I know the government is behind
schedule.

Here is the Advisory Board tabulation of accounts
created and people enrolled.

EntityAccountsPeople
Enrolled

Federal government __ __

California125,959 __

Colorado18, 174395

Connecticut10, 7683847

Hawaii1,
181__

Kentucky51,48226, 194

Maryland40, 703___

Massachusetts25, 703___

Minnesota18,9173,769

Nevada38,3931,757

New York___37,030

Oregon11,500____

Rhode Island7,4822.652

Vermont8,7391,588

Washington89, 27335,578Note: __ means no information is available.

Tweet:
Red
states depending on healthcare.gov lag behind blue -purple states running their
own exchanges in enrolling people in health exchanges.

Saturday, October 26, 2013

ObamaCare
Fantasies and Krauthammer Realities

We
have been seduced by computer glamour …Glamour is a powerfully pervasive tool.
Taken as a guide rather than the literal truth, it can lead to positive
lifestyle action.But it is also an
illusion. In the real world hidden details matter.

Virginia
Postrel, “Obama’s Virtual Fantasy Coludn’t Handle Messy Reality, Bloomberg, October 24, 2013When you run something this large, it has no chance of succeeding.Charles Krauthammer, MD (born 1950), on Fox News video discussing Obamacare and healthcare.gov

Two fantasies have seduced President Obama..

One: the
government elite and its central planners know what’s best for people and can virtually
manage their personal and health affairs.

Two:the
computer and its spin-offs is a powerful and pervasive force capable of managing society down to the last detail.

In his new book,Things That Matter: Three Decades
of Passions, Pastimes, and Politics,Charles
Krauthammer, MD, a political columnist and a psychiatrist,puts these two fantasies into perspective.

To begin with,he says, it is important to get the politics right. In his book, he talks of hisjourney from being a life-long Democrat and a Great Society liberal to a reluctant Reagan
admirer to a contributor to Fox News and a commentator widely regarded as the
most persuasive voice of American conservatism.He notes that he is not the first to make
the journey from liberralism to conservatism..Ronald Reagan,Irving Kristol,Pat Moynihan, and others made that same journey before him.He expresses his opinions in a weekly
Washington Post column,syndicated in
350 newspapers,and in numerous talk
shows, the most notable of which is a nightly Fox News appearance.

Krauthammer’s voice is not shrill. It is pragmatic, reasonable,empirical, nonpartisan.He is simply saying that the
Leviathan government model doesn’t work in the real world.A more limited smaller government works
better and is more in keeping with individual, aspirations, skills, dreams, and freedoms.

He read widely before reaching these conclusions. Though his reading and his own empirical observations, he became slowly converted “ to a philosophy of restrained,
free-market governance that gave more space and place to the individual and to
the civil society that stands between citizen and state.”

A
doctor, graduated from Harvard
Medical School and trained as a psychiatrist at Massachusetts General Hospital,
where he served as chief resident in Psychiatry He regards the health care system as a delicate
ecosystemdeveloped over the course of
70 years. The professon, he feels, is not capable of being overturned or transformed by federal
mandates and bureaucratic regulations.

Tweet:That
healthcare.gov and other computer apps can transform medicine and that government
knows best is fantasy now colliding with reality.

The Health Reform Maze

Buy the Book

Book Description: In this first book in a series of four, Richard L. Reece, MD. provides a unique view of the roll out, and run up, of the Affordable Care Act. Reece shows in this book the progress and facets of ObamaCare's marketers and messengers, as the day approached for the launch of health insurance exchanges - the single most public and problematic portion of the new law. This is a must read for anyone who wants to chronicle this attempt to organize more than one-sixth of the U.S. economy by adding layers of federal government control and regulations.

Reece has been writing about U.S. health care for more than 45 years. His knowledge and experience, added to his keen intellect and gift of subtle humor, make this book a valuable part of anyone's collection.